Factors affecting local control of pulmonary oligometastases treated with stereotactic body radiotherapy

Sharma, Aman; Duijm, M.; Hoop, Esther Oomen–de; Aerts, Joachim; Verhoef, Cornelis; Hoogeman, M.; Nuyttens, J.

doi:10.1080/0284186x.2018.1445285

Cited by 34 publications

(62 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The median number of fractions employed was 3 (range: 1-8), how many lesions were treated with SFRS remains unclear. Other trials rarely report significance of BED and fractionation regiments on treatment outcome for metastases according to size (9,21). Nevertheless, the existing data on size-adapted SFRS for lung metastases as well as primary lung tumors is promising with 1 year LC rates varying from 89.1%-93.4 % (15,(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Radiosurgery and fractionated stereotactic body radiotherapy for patients with lung oligometastases

Kalinauskaitė

Tinhofer

Kufeld

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Patients with oligometastatic disease can potentially be cured by using an ablative therapy for all active lesions. Stereotactic body radiotherapy (SBRT) is a non-invasive treatment option that lately proved to be as effective and safe as surgery in treating lung metastases (LM).However, it is not clear which patients benefit most and what are the most suitable fractionation regimes. The aim of this study was to analyze treatment outcomes after single fraction radiosurgery (SFRS) and fractionated SBRT (fSBRT) in patients with lung oligometastases and identify prognostic clinical features for better survival outcomes. Methods: Fifty-two patients with 94 LM treated with SFRS or fSBRT between 2010 and 2016 were analyzed. The characteristics of primary tumor, LM, treatment, toxicity profiles and outcomes were assessed. Kaplan-Meier and Cox regression analyses were used for estimation of local control (LC), overall survival (OS), progression free survival and distant metastases free survival (DMFS). Results: Ninety-four LM in 52 patients were treated using SFRS/fSBRT with a median of 2 lesions per patient (range: 1-5). The median planning target volume (PTV)-encompassing dose for SFRS was 24 Gy (range: 17-26) compared to 45 Gy (range: 20-60) in 2-12 fractions in fSBRT. The median follow-up time was 21 months (range: 3-68). LC rates at 1 and 2years for SFSR vs. fSBRT were 89% and 83% vs. 75% and 59%, respectively (p=0.026). LM treated with SFSR were significantly smaller (p=0.001). The 1 and 2-year OS rates for all patients were 84% and 71%, respectively. In univariate analysis treatment with SFRS, an interval of ≥ 12 months between diagnosis of LM and treatment, non-colorectal cancer histology and BED <100 Gy were significantly associated with better LC. However, none of these parameters remained significant in the multivariate Cox regression model. OS was significantly better in patients with negative lymph nodes (N0), Karnofsky performance status (KPS) >70% and time to first metastasis ≥12 months. There was no grade 3 acute or late toxicity. Conclusions: We observed good LC and low toxicity rates after SFRS for small lung metastases. Longer time to first metastasis, good KPS and N0 predicted better OS. BackgroundMetastatic progression of cancer is linked to poor prognosis and is the leading cause of cancer-related deaths (1). Few decades ago, the diagnosis of metastatic disease was related with lethal outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Our findings are comparable with the current findings in the literature (Tab. 7) (8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Section: Discussionmentioning

confidence: 99%

Radiosurgery and fractionated stereotactic body radiotherapy for patients with lung oligometastases

Kalinauskaitė

Tinhofer

Kufeld

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…SBRT is a modern radiation technique that delivers a high dose to the tumor in a small number of fractions. For patients with pulmonary oligometastatic disease, SBRT achieves excellent local control and is associated with limited toxicity [9][10][11][12][13][14][15][16][17][18][19][20][21]. Patients treated with SBRT are usually not suitable for surgery, are often elderly and have multiple co-morbidities.…”

Section: Introductionmentioning

confidence: 99%

Survival and prognostic factors of pulmonary oligometastases treated with stereotactic body radiotherapy

et al. 2018

Self Cite

View full text Add to dashboard Cite

Background: Stereotactic body radiotherapy (SBRT) for pulmonary oligometastatic disease achieves excellent treatment outcomes in terms of local control and toxicity. Patients treated with SBRT are often elderly and have multiple co-morbidities. This subset of patients may experience different survival as compared to young and fit patients subjected to radical metastasectomies. The purpose of this retrospective study was to evaluate OS and identify factors associated with OS for inoperable pulmonary oligometastases treated with SBRT. Material and methods: Criteria used for selection of patients with oligometastases included: metastases limited to 2 organs and in total 5 metastases at the time of treatment. Peripheral tumors were treated with 51 Gy to 60 Gy in three fractions or a single fraction of 30 Gy. Central tumors received a dose of 45-60 Gy in 5-8 fractions. Survival probabilities were estimated by means of Kaplan-Meier method and the relation between potential prognostic factors and OS was studied by means of Cox regression analyses. Results: In this study, 327 inoperable pulmonary oligometastases in 206 patients were treated with SBRT from the year 2005 to 2015. Primary sites of pulmonary oligometastases included colorectal carcinoma (n ¼ 118), lung carcinoma (n ¼ 36), melanoma (n ¼ 11), sarcoma (n ¼ 10), breast carcinoma (n ¼ 7), and other tumors sites (n ¼ 24). Median follow-up was 26 months. Median survival was 33 months. The 2-year and 5-year OS rates were 63% and 30%, respectively. On univariate analysis synchronous oligometastases (HR 0.59) and colorectal primary (HR 0.64) were associated with improved OS. On multivariable analysis synchronous oligometastases (HR 0.56), colorectal primary (HR 0.62) and tumor size <3 cm (HR 0.68) were independently associated with OS. Conclusions: SBRT to pulmonary oligometastases was associated with a 2-year OS of 63%. Tumor size <3 cm and colorectal primary tumors experienced improved OS compared to tumors >3 cm and noncolorectal primary tumors.

show abstract

“…In a large series of oligometastatic patients from different primaries and various sites, the administration of systemic therapies prior to SBRT predicted a higher risk of progression, with an HR of 1.19 [35]. Similarly, Sharma et al reported poorer local control in patients previously treated with chemotherapy in a large database of 327 pulmonary oligometastases from miscellaneous primary tumors [36].…”

Section: Discussionmentioning

confidence: 95%

Stereotactic Radiotherapy for Ultra-Central Lung Oligometastases in Non-Small-Cell Lung Cancer

Loi

Franceschini

Dominici

et al. 2020

Cancers

View full text Add to dashboard Cite

Background: Stereotactic body radiotherapy (SBRT) in ultra-central (UC) lung tumors, defined in the presence of planning target volume (PTV) overlap or direct tumor abutment to the central bronchial tree or esophagus, may be correlated to a higher incidence of severe adverse events. Outcome and toxicity in oligometastatic (≤3 metastases) non-small-cell lung cancer (NSCLC) patients receiving SBRT for UC tumors were evaluated. Methods: Oligometastatic NSCLC patients treated with SBRT for UC were retrospectively reviewed. Local control (LC), distant metastasis-free survival (DMFS), progression-free survival (PFS) and overall survival (OS) were calculated. Incidence and grade of toxicity were evaluated. Statistical analysis was performed to assess the impact of clinical and treatment-related variables on outcome and toxicity occurrence. Results: Seventy-two patients were treated to a median biologically effective dose (BED) of 105 (75–132) Gy10. Two-year LC, DMFS, PFS, and OS were 83%, 46%, 43%, and 49%. BED>75 Gy10 was correlated to superior LC (p = 0.02), PFS (p = 0.036), and OS (p < 0.001). Grade ≥3 toxicity rate was 7%, including one fatal esophagitis. No variables were correlated to DMFS or to occurrence of overall and grade ≥3 toxicity. Conclusions: SBRT using dose-intensive schedules improves outcome in NSCLC patients. Overall toxicity is acceptable, although rare but potentially fatal toxicities may occur.

show abstract

Factors affecting local control of pulmonary oligometastases treated with stereotactic body radiotherapy

Abstract: SBRT achieved an excellent LC of 85% at 2 years. Although retrospective in nature, our study identified three factors associated with inferior LC. These factors may help to refine SBRT practice for pulmonary oligometastases in the future.

Cited by 34 publications

References 33 publications

Radiosurgery and fractionated stereotactic body radiotherapy for patients with lung oligometastases

Radiosurgery and fractionated stereotactic body radiotherapy for patients with lung oligometastases

Survival and prognostic factors of pulmonary oligometastases treated with stereotactic body radiotherapy

Stereotactic Radiotherapy for Ultra-Central Lung Oligometastases in Non-Small-Cell Lung Cancer

Contact Info

Product

Resources

About